Healthcare Provider Details

I. General information

NPI: 1033076765
Provider Name (Legal Business Name): DANIEL CRAIG BIRD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W5665 KOSS RD
ONALASKA WI
54650-8816
US

IV. Provider business mailing address

W5665 KOSS RD
ONALASKA WI
54650-8816
US

V. Phone/Fax

Practice location:
  • Phone: 608-397-5782
  • Fax:
Mailing address:
  • Phone: 608-397-5782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: